Raising Concerns and Whistle Blowing
The Royal College of Surgeons of Edinburgh (RCSEd) upholds an ethos of providing and supporting the tools for the delivery of high-quality healthcare. The College acknowledges that there may be occasions when concerns arise regarding the standard of care provided by either an individual or an institution, falling below an acceptable level.
Doctors have a professional duty under the GMC's Good Medical Practice (2024) to:
"promote and encourage a culture that allows all staff to raise concerns openly and safely"...."take prompt action" where "patient safety, dignity or comfort is or may be seriously compromised."
The College is committed to fostering increased openness and transparency in healthcare, encouraging prompt action to address instances of malpractice or other serious health and safety concerns that may impact patient care. It's important to note that in this guide, we use the terms 'raising concerns', 'whistleblowing', and 'speaking up' interchangeably.
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The Legal Background
In the UK, the Employment Rights Act 1996 (NHS Recruitment – Protected Disclosure) Regulations 2018 and the Public Interest Disclosure Act 1998 offer some protection to those who raise concerns where:
- A criminal offence is being committed;
- A person is failing to comply with their legal obligations;
- A miscarriage of justice is occurring;
- Health and safety is being endangered;
- There is environmental damage; or
- Information showing any of the above has been or is likely to be concealed.
In very broad terms, legal protection applies in cases where the claimant reasonably believes their concerns are factually correct and in the public interest. Individuals looking to raise concerns should always consider whether patient harm could be caused if a situation is left unchecked. Concerns are more likely to be taken seriously as ‘protected disclosures’ if they contain a factual statement of what is wrong.
Please note that bullying and undermining are often treated under separate grievance or dignity at work policies. Explore Bullying and Undermining resources.
Raising a Concern Steps
If concerns are to be raised, we recommend the following steps:
Step One
It is important that those wishing to raise concerns familiarise themselves with these Acts and liaise with experts such as their local BMA/BDA representative and/or Medical Defence Union.
Clinicians in England can also contact their local Freedom to Speak up Guardian. Guardians ensure that people who speak up are thanked, that the issues they raise are responded to, and make sure that the person speaking up receives feedback on the actions taken.
Step Two
The HR department should be contacted in order to view the employer's raising concerns policy. All employers should have a formal policy and guidance for raising concerns, so these should be familiarised with, as they are designed to protect individuals.
Step Three
Concerns should be raised with the immediate clinical team, line manager, or head of department. If this is unsuitable, the employer’s raising concerns policy should include a formal procedure and the name of a designated officer.
The raising concerns policy may require reporting concerns in writing or via an incident reporting system such as Datix. This is advisable, as written submissions provide greater legal protection and increase the likelihood that concerns are acted upon.
Step Four
You can raise your concerns with your Trust’s Medical Director and/or Chief Executive.
As internal disclosures are more readily protected under the legal framework, we recommend that concerns should only be raised externally after they have been raised internally first. Social media must not be used to discuss concerns.
Advice for Trainees'
Trainees' should initially liaise with their Educational Supervisor. If this proves unsuitable or unsuccessful, they should escalate the matter to their Training Programme Director. Subsequently, they can approach the Head of School of Surgery, and ultimately the Postgraduate Dean, who serves as the trainees' Responsible Officer. Trainees' also have the option to raise concerns with the GMC, which has the authority to consider removing trainees from a training programme if necessary.
The College Trainees' Committee may offer informal opinions and advice.
RCSEd Code of Conduct
The Royal College of Surgeons of Edinburgh encourages a culture that emphasises the importance of raising concerns and that such concerns are investigated and assessed fairly. Where it is identified, through appropriate College procedures, that there has been a failure to meet the Code of Conduct, steps will be taken to address such behaviours and appropriate sanctions applied. This may include suspension from the College or associated duties until the College has deliberated.
The College Code of Conduct, a document meticulously crafted to guide our members through the ethical, probity, and behavioural standards expected in the pursuit of excellence.
RCSEd Code of Conduct
Further Information and Support
- Care Quality Commission - Guide to raising a concern about your workplace
- NHS England - National speak up policy
- General Medical Council - How to raise your concern or refer yourself
- Health Education England - Raising and responding to concerns
- NHS Employers - The use of settlement agreements and confidentiality clauses
- NHS Improvement - Asking for advice or raising complaints and concerns
- ‘Speak Up’ offers a free, independent and confidential helpline for people working in NHS and Social Care organisations in England - (08000 724 725).
- Protect is a whistleblowing charity which provides legal advice to whistleblowers, supports employer with whistleblowing arrangements and informs public policy - (020 3117 2520).
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